The special issue presents new studies and commentaries on the benefits and increasing use of CAM techniques in the Veterans Health Administration (VHA) and other military health settings. "The papers in this supplement represent promising steps to improve the health of veterans and active military personnel," according to an introductory article by Guest Editors Stephanie L. Taylor, PhD, of Greater Los Angeles VA Healthcare System and A. Rani Elwy, PhD, of Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass. "They mirror the countless stories we hear from veterans and their providers about the positive effect that CAM is having on their lives."

Studies Show Value of CAM for Improving Health of Military Personnel

The supplement presents 14 original studies reporting on specific CAM therapies and on the current use, perceptions, and acceptance of CAM in veterans and current military personnel. The special issue of Medical Care is sponsored by the VHA's Office of Patient Centered Care and Cultural Transformation.

Complementary and alternative medicine therapies are increasingly available, used, and appreciated by military patients, according to Drs Taylor and Elwy. They cite statistics showing that CAM programs are now offered at nearly 90 percent of VA medical facilities. Use CAM modalities by veterans and active military personnel is as at least as high as in the general population.

Previous systematic reviews have reported benefits of CAM treatments for many of the important problems seen in military populations, including chronic pain, anxiety, posttraumatic stress disorder (PTSD), and depression. Those prior results suggest that CAM therapies are "moderately effective" for these conditions--although these conclusions must be weighed against the weaknesses of the evidence base.

Highlights of the research included in the special issue include:

Studies reporting benefits of specific types of meditation practices. One study finds that a mindfulness-based intervention reduced depression and improved psychological well-being in veterans with PTSD. A study of mindfulness-based stress reduction for veterans shows reductions in anxiety and depression, as well as suicidal thoughts.

A report showing beneficial effects of acupuncture for veterans with PTSD. In addition to reduced severity of PTSD symptoms, the study shows improvements in depression, pain, and physical and mental health functioning. Another study finds that most veterans use vitamins and nutritional supplements, often substituting them for prescription drugs.

Studies showing high rates of use and favorable perceptions found of CAM modalities among veterans of the Gulf War and Operation Enduring Freedom/Operation Iraqi Freedom. Veterans with PTSD are more likely to be accepting of CAM therapies.

Reports describing the rates and preferred types of CAM mind-body and other modalities among military members and veterans, as well as on health care providers' attitudes toward CAM. While VA providers vary in their knowledge of CAM, many perceive benefits for their patients.

A commentary by Laura P. Krejci, MSW, and colleagues of the VA's Office of Patient Centered Care & Cultural Transformation discusses the role of CAM in meeting the "number one strategic priority" of providing "personalized, proactive, patient-driven health care to veterans." Dr Wayne B. Jonas and colleagues of the Samueli Institute, Alexandria, Va., draw attention to several bodies of research on CAM in the US military. They conclude that current policy and priorities leave "the majority of active duty service members, veterans, and their families to fend for themselves, to pay for or go without the beneficial effects of CAM and integrative medicine practices."

While the studies in the special issue show progress, Drs Taylor and Elwy stress the need for additional rigorous research to better understand CAM's potential for managing important conditions seen in military populations. They conclude, "It is time for more funding to be awarded to CAM ...to improve the capacity of the field to carry out rigorous CAM research, which in turn will benefit veterans and military personnel, as well as the general population."

Thursday, November 6, 2014

Pain is a common symptom of cancer and side effect of cancer treatment, and treating cancer-related pain is often a challenge for health care providers.The Penny George Institute for Health and Healing researchers found that integrative medicine therapies can substantially decrease pain and anxiety for hospitalized cancer patients. Their findings are published in the current issue of the Journal of the National Cancer Institute Monographs."Following Integrative medicine interventions, such as medical massage, acupuncture, guided imagery or relaxation response intervention, cancer patients experienced a reduction in pain by an average of 47 percent and anxiety by 56 percent," said Jill Johnson, Ph.D., M.P.H., lead author and Senior Scientific Advisor at the Penny George Institute."The size of these reductions is clinically important, because theoretically, these therapies can be as effective as medications, which is the next step of our research," said Jeffery Dusek, Ph.D., senior author and Research Director for the Penny George Institute.The Penny George Institute receives funding from the National Center of Alternative and Complementary Medicine of the National Institutes of Health to study the impact of integrative therapies on pain over many hours as well as over the course of a patient's entire hospital stay."The overall goal of this research is to determine how integrative services can be used with or instead of narcotic medications to control pain," Johnson said.Researchers looked at electronic medical records from admissions at Abbott Northwestern Hospital between July 1, 2009 and December 31, 2012. From more than ten thousand admissions, researchers identified 1,833 in which cancer patients received integrative medicine services.Patients were asked to report their pain and anxiety before and just after the integrative medicine intervention, which averaged 30 minutes in duration.Patients being treated for lung, bronchus, and trachea cancers showed the largest percentage decrease in pain (51 percent). Patients with prostate cancer reported the largest percentage decrease in anxiety (64 percent).